Although sleeping pills are a popular choice, the American College of Physicians (ACP), in its first-ever practice guideline for the management of chronic insomnia, recommends that patients first try six to eight sessions of a type of talk therapy called cognitive behavioural therapy. The ACP is a national organization of internal medicine doctors, and its guideline is based on reviews of the scientific evidence.
That includes a review sponsored by the Agency for Healthcare Research and Quality which examined evidence from 35 drug trials and 11 long-term studies, along with FDA review data. The review found that while drugs may provide a short-term fix, they may cause behavioural changes and changes in thinking ability.
About 6% to 10% of U.S. adults meet the criteria for chronic insomnia, which specify that symptoms – namely the inability to fall asleep or difficulty in staying asleep — occur at least three nights a week for three months and cause significant distress or impairment.
WebMD talked with ACP president Wayne Riley, MD, MPH, clinical professor of medicine at Vanderbilt University School of Medicine, about the preferred treatments for chronic insomnia.
WebMD: What is chronic insomnia?
Riley: Everybody has a sleepless night occasionally. We’re talking about chronic insomnia. It’s night after night, week after week. It’s very debilitating. They’re showing up at work very drowsy. They’re moody. They’re overly fatigued. Obviously, that takes a toll.
WebMD: Why did the ACP see a need for a guideline for managing chronic insomnia?
Riley: Many of us who practice internal medicine hear, “Doc, I’m having trouble sleeping, or if I go to sleep, I wake up in the middle of the night. I don’t feel rested. I’m drowsy at work. I feel sleepy when I’m driving my kids to school.” It’s a common complaint that we get from patients. It’s one of those complaints that sometimes physicians feel a little unprepared or unaware of how to effectively treat. We’re clearly saying that the first-line therapy for insomnia should be cognitive behavioural therapy, not sleep medications. This will definitely start a conversation and really plant a seed in the minds of both physicians and patients.
WebMD: Why shouldn’t medication be the first line of treatment?
Riley: People forget that sleep medications have the potential of serious adverse effects. Let’s try to get away from over-prescribing of sleep medications. These medications can be pricey. They have some potential to cause dependency. But we know that good cognitive behavioural therapy for insomnia is incredibly safe.
WebMD: What is cognitive behavioural therapy for insomnia?
Riley: A cognitive behavioural therapist will put a patient through a number of breathing exercises and get them to talk about their stressors. “Okay, I’m worried about my daughter’s dental appointment tomorrow.” Worry about it for two minutes, and then it’s out of your mind. Get your worry out before you get in bed. Not all clinical psychologists are able to do cognitive behavioural therapy. Given the fact that we may not have the capacity [to treat every chronic insomnia patient], we even mention in the paper that group therapy can be equally effective as individual therapy. Sometimes the web-based modules or even some self-help books can be very helpful.
WebMD: Should doctors ever prescribe drugs to help patients sleep?
Riley: Sleep medications have their role, but the first-line approach should be cognitive behavioural therapy. If that doesn’t help the patient, then you can combine cognitive behavioural therapy with short-term sleep medications. And we do mean short-term—no more than four to five weeks. Beyond four to five weeks, you develop dependency. You don’t want to harm patients by having them “hooked” on sleep medication.
WebMD: What are some other non-drug approaches to dealing with insomnia, whether chronic or occasional?
Riley: Get the TV out of the bedroom. Don’t look at your iPad for at least a couple of hours before you go to bed. Get into a relaxing routine, such as reading a good book or listening to your favourite jazz or classical music that gets you in the mood to wind down so that you can fall asleep. That’s what we refer to as sleep hygiene.
WebMD: What would you say to people who think it’s easier to take a pill than bother with cognitive behavioural therapy?
Riley: The other aspect of this, quite frankly, is cost. You may only need three or four sessions of cognitive behavioural therapy to address your chronic insomnia, but if you’re on sleep medications for four, five, six months, that’s quite expensive. If it’s a brand name sleep medication that’s advertised on TV, likely that’s going to be more expensive than generic forms of sleep medication.
Scientists make ‘second skin’ to hide wrinkles
SCIENTISTS claim to have developed an invisible elastic film that can be applied to the skin to reduce the appearance of wrinkles and eye bags.
Once applied, the formula dries to form a film that “mimics the properties of youthful skin”, Nature Materials reports after a series of small trials.
At the moment it is being explored as a commercial cosmetic product.
But the US scientists say their “second skin” might eventually be used to deliver medicines and sun protection.
The team from Harvard Medical School and the Massachusetts Institute of Technology have tested their prototype product on a handful of volunteers, applying the formula to their under-eye bags, forearms and legs.
The polysiloxane polymer was made in the lab using molecules of silicone and oxygen as the building blocks.
Although it’s synthetic, it’s designed to mimic real skin and provide a breathable, protective layer.
According to the researchers, the temporary film locks in moisture and helps boost skin elasticity.
They performed several tests, including a recoil test where the skin was pinched and then released to see how long it takes to ping back into position.
As skin ages, it becomes less firm and less elastic and so performs less well in this sort of test.
Skin that had been coated with the polymer was more elastic than skin without the film. And, to the naked eye, it appeared smoother, firmer and less wrinkly.
The researchers, who have a spin-off company that could eventually market their patented formula, say the film is essentially invisible, can be worn all day without causing irritation and can withstand things like sweat and rain.
But more studies are needed before then. The polymer would also need safety approval from regulators.
Dr Tamara Griffiths of the British Association of Dermatologists says bags under the eyes are caused by the protrusion of fat pockets associated with ageing.
While entirely natural, some people see it as undesirable and seek ways to reverse it – sometimes resorting to surgery.
Dr Griffiths said: “The results [with the polymer film] appear to be comparable to surgery, without the associated risks. Further research is needed, but this is a novel and very promising approach to a common problem. I will follow its development with interest.”
Prof Robert Langer, who led the work at MIT, said: “Developing a second skin that is invisible, comfortable and effective in holding in water and potentially other materials presents many different challenges.
“It has to have the right optical properties, otherwise it won’t look good, and it has to have the right mechanical properties, otherwise it won’t have the right strength and it won’t perform correctly.
“We are extremely excited about the opportunities that are presented as a result of this work and look forward to further developing these materials to better treat patients who suffer from a variety of skin conditions.”